Early menopause linked to worse outcomes after acute coronary syndrome

A multicenter registry analysis published in Menopause assessed whether early menopause predicted outcomes after acute coronary syndrome (ACS) in women aged 60 years or younger. The registry covered ACS hospitalizations from February 2020 through February 2025. Of 1,039 records, 857 contained valid menopausal age data and 728 met the requirement that menopause preceded or coincided with ACS. Among these women, 124 had menopause before age 45. The primary outcome was a prespecified ischemic/cardiovascular major adverse cardiovascular event.

Over a median 3.52 years, crude primary outcome rates were 21.1% with early menopause versus 13.3% with later menopause. Death rates were 8.9% versus 4.6%, and composite outcome rates were 25.2% versus 15.3%. In the primary clinical Cox model, early menopause was associated with the primary outcome (hazard ratio [HR], 1.78; 95% CI, 1.11–2.85), death (HR, 2.57; 95% CI, 1.18–5.57), and the composite outcome (HR, 1.87; 95% CI, 1.21–2.89).

Associations attenuated in extended exploratory models including previous vascular disease, surgical menopause, and hormone therapy. The findings support recording menopausal age when assessing women after ACS, but this observational analysis cannot establish causality. Menopausal age came from registry or clinical history fields, and the supplied report does not detail the components of the primary and composite outcomes.